Breathing assistance apparatus

ABSTRACT

A breathing assistance apparatus is designed for use with delivery of respiratory gases to a patient. The breathing assistance apparatus includes a patient interface, having a body section adapted to cover the nose, or nose and mouth of a patient and a sealing interface. The sealing interface includes at least an outer sealing member. The outer sealing member (201) is adapted to attach to the body section in a sealing manner and has a substantially thin section (203) in at least its nasal bridge region. The thin section is substantially thinner than the rest of the outer sealing member.

BACKGROUND OF THE INVENTION

Field of the Invention

This invention relates to patient interfaces particularly though notsolely for use in delivering CPAP therapy to patients suffering fromobstructive sleep apnoea (OSA).

Description of the Related Art

In the art of respiration devices, there are well known variety ofrespiratory masks which cover the nose and/or mouth of a human user inorder to provide a continuous seal around the nasal and/or oral areas ofthe face such that gas may be provided at positive pressure within themask for consumption by the user. The uses for such masks range fromhigh altitude breathing (i.e., aviation applications) to mining and firefighting applications, to various medical diagnostic and therapeuticapplications.

One requisite of such respiratory masks has been that they provide aneffective seal against the user's face to prevent leakage of the gasbeing supplied. Commonly, in prior mask configurations, a goodmask-to-face seal has been attained in many instances only withconsiderable discomfort for the user. This problem is most crucial inthose applications, especially medical applications, which require theuser to wear such a mask continuously for hours or perhaps even days. Insuch situations, the user will not tolerate the mask for long durationsand optimum therapeutic or diagnostic objectives thus will not beachieved, or will be achieved with great difficulty and considerableuser discomfort.

U.S. Pat. Nos. 5,243,971 and 6,112,746 are examples of prior artattempts to improve the mask system U.S. Pat. No. 5,570,689 and PCTpublication No. WO 00/78384 are examples of attempts to improve theforehead rest.

Where such masks are used in respiratory therapy, in particulartreatment of obstructive sleep apnea (OSA) using continuance positiveairway pressure (CPAP) therapy, there is generally provided in the art avent for washout of the bias flow or expired gases to the atmosphere.Such a vent may be provided for example, as part of the mask, or in thecase of some respirators where a further conduit carries the expiratorygases, at the respirator. A further requisite of such masks is thewashout of gas from the mask to ensure that carbon dioxide build up doesnot occur over the range of flow rates. In the typical flow rates in CPAP treatment, usually between 4 cm H₂O to 20 cm H₂O, prior art attemptsat such vents have resulted in excessive noise causing irritation to theuser and any bed partners.

In common with all attempts to improve the fit, sealing and user comfortis the need to avoid a concentrated flow of air at any portion of therespiratory tracts. In particular with oral masks or mouthpieces it is adisadvantage of prior art devices that the oral cavity may become overlydehydrated by use of the device, causing irritation and possible latercomplications. Furthermore, a common complaint of a user of CPAP therapyis pressure sores caused by the mask about the nose and face and inparticular in the nasal bridge region of the user.

SUMMARY OF THE INVENTION

It is an object of the present invention to attempt to provide a patientinterface which goes some way to overcoming the abovementioneddisadvantages in the prior art or which will at least provide theindustry with a useful choice.

Accordingly in a first aspect the present invention consists in abreathing assistance apparatus, for use with delivery of respiratorygases to a patient comprising: a patient interface, having a bodysection adapted to cover the nose, or nose and mouth of said patient, asealing interface, including at least an outer sealing member, saidouter sealing member adapted to attach to said body section in a sealingmanner, said outer sealing member having a substantially thin section inat least its nasal bridge region, said thin section being substantiallythinner than the rest of said outer sealing member, wherein said outersealing member is adapted to seal around the facial contours of saidpatient thereby providing a sealed fluid communication to therespiratory tract of said patient.

The invention consists in the foregoing and also envisages constructionsof which the following gives examples.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred forms of the present invention will now be described withreference to the accompanying drawings.

FIG. 1 is a block diagram of a humidified continuous positive airwaypressure (system) as might be used in conjunction with the sealinginterface of the present invention.

FIG. 2 is an illustration of the nasal mask including a sealinginterface in use according to the preferred embodiment of the presentinvention.

FIG. 3 shows a perspective view of a mask with a sealing interface thatis a cushion.

FIG. 4 is a cutaway view of the mask showing the sealing interfacecushion that has an inner sealing member and an outer sealing member.

FIG. 5 is a cutaway view of the periphery of the outer sealing member ormembrane.

FIG. 6 is a cutaway view of the periphery of the mask body portion.

FIG. 7 shows a mask and sealing interface as used with a forehead reston a patient.

FIG. 8 shows a cross section of a second preferred embodiment of thesealing interface.

FIG. 9 shows perspective view of an inner sealing member of the secondpreferred embodiment of the sealing interface.

FIG. 10 shows a cross section of a third preferred embodiment of theinner and outer sealing members of the present invention.

FIG. 11 shows a perspective view of the inner sealing member of thethird preferred embodiment of the sealing interface.

FIG. 12 shows a plan view of the inner sealing member of the thirdpreferred embodiment of the mask cushion.

FIG. 13 shows a cross section of a fourth preferred embodiment of thesealing interface of the present invention.

FIG. 14 shows a perspective view of the inner sealing member accordingto a fifth preferred embodiment of the sealing interface of the presentinvention.

FIG. 15 shows a cross section of a sixth preferred embodiment of thesealing interface of the present invention.

FIG. 16 shows a perspective view of the inner sealing member accordingto a seventh preferred embodiment of the sealing interface of thepresent invention.

FIG. 17 shows a perspective view of the inner sealing member accordingto an eighth preferred embodiment of the sealing interface of thepresent invention.

FIG. 18 shows a perspective view of the inner sealing member accordingto a ninth preferred embodiment of the sealing interface of the presentinvention.

FIG. 19 shows a perspective view of the inner sealing member accordingto a tenth preferred embodiment of the sealing interface of the presentinvention.

FIG. 20 shows a cross section of a further embodiment of the sealinginterface of the present invention where the inner sealing foam membertouches the outer sealing member at all times.

FIG. 21 is a side view of a nasal mask of the present invention wherethe outer sealing member is substantially thinner in width in the nasalbridge region than the rest of the outer sealing member.

FIG. 22 is a close-up view of detail A in FIG. 21.

FIG. 23 is a perspective view of the nasal mask of FIG. 21.

FIG. 24 is a cross-section of the outer sealing member of FIG. 21.

FIG. 25 is a front perspective view of a full face mask of the presentinvention, where the outer sealing member is substantially thinner inwidth in the nasal bridge region than the rest of the outer sealingmember.

FIG. 26 is a back perspective view of a full face mask of FIG. 25.

FIG. 27 is a cross-section through BB of the full face mask of FIG. 25.

FIG. 28 is a perspective view of the outer sealing member of the fullface mask of FIG. 25 in isolation, where the thin nasal bridge region isparticularly shown.

FIG. 29 is a cross-section through CC of the outer sealing member ofFIG. 28.

FIG. 30 is a front view of the outer sealing member of FIG. 28.

FIG. 31 is a front view of a first alternative outer sealing member.

FIG. 32 is a front view of a second alternative outer sealing member.

FIG. 33 is a front view of a third alternative outer sealing member.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The sealing interface of the present invention provides improvements inthe delivery of CP AP therapy. In particular a patient interface isdescribed which reduces the pressure of the mask on the patient's faceand may be quieter for the patient to wear and reduces the side leakageas compared with the prior art. It will be appreciated that the patientinterface as described in the preferred embodiment of the presentinvention can be used in respiratory care generally or with aventilator, but will now be described below with reference to use in ahumidified CP AP system. It will also be appreciated that the presentinvention can be applied to any form of patient interface including, butnot limited to, nasal masks, oral masks and mouthpieces.

With reference to FIG. 1 a humidified Continuous Positive AirwayPressure (CP AP) system is shown in which a patient 1 is receivinghumidified and pressurized gases through a patient interface 2 connectedto a humidified gases transportation pathway or inspiratory conduit 3.It should be understood that delivery systems could also be VPAP(Variable Positive Airway Pressure) and BiPAP (Bi-level Positive AirwayPressure) or numerous other forms of respiratory therapy. Respiratoryconduit 3 is connected to the outlet 4 of a humidification chamber 5that contains a volume of water 6. Inspiratory conduit 3 may containheating means or heater wires (not shown) which heat the walls of theconduit to reduce condensation of humidified gases within the conduit.Humidification chamber 6 is preferably formed from a plastics materialand may have a highly heat conductive base (for example an aluminiumbase) which is in direct contact with a heater plate 7 of humidifier 8.Humidifier 8 is provided with control means or electronic controller 9which may comprise a microprocessor based controller executing computersoftware commands stored in associated memory.

Controller 9 receives input from sources such as user input means ordial 10 through which a user of the device may, for example, set apredetermined required value (preset value) of humidity or temperatureof the gases supplied to patient I. The controller may also receiveinput from other sources; for example temperature and/or flow velocitysensors 11 and 12 through connector 13 and heater plate temperaturesensor 14. In response to the user set humidity or temperature valueinput via dial 10 and the other inputs, controller 9 determines when (orto what level) to energize heater plate 7 to heat the water 6 withinhumidification chamber 5. As the volume of water 6 within humidificationchamber 5 is heated, water vapour begins to fill the volume of thechamber above the water's surface and is passed out of thehumidification chamber 5 outlet 4 with the flow of gases (for exampleair) provided from a gases supply means or blower 15 which enters thechamber through inlet 16. Exhaled gases from the patient's mouth arepassed directly to ambient surroundings in FIG. 1.

Blower 15 is provided with variable pressure regulating means orvariable speed fan 21 which draws air or other gases through blowerinlet 17. The speed of variable speed fan 21 is controlled by electroniccontroller 18 (or alternatively the function of controller 18 couldcarried out by controller 9) in response to inputs from controller 9 anda user set predetermined required value (preset value) of pressure orfan speed via dial 19.

Nasal Mask

According to a first embodiment of the present invention the patientinterface is shown in FIG. 2 as a nasal mask. The mask includes a hollowbody 102 with an inlet 103 connected to the inspiratory conduit 3. Themask 2 is positioned around the nose of the patient 1 with the headgear108 secured around the back of the head of the patient 1. Therestraining force from the headgear 108 on the hollow body 102 and theforehead rest 106 ensures enough compressive force on the mask cushion104, to provide an effective seal against the patient's face.

The hollow body 102 is constructed of a relatively inflexible materialfor example, polycarbonate plastic. Such a material would provide therequisite rigidity as well as being transparent and a relatively goodinsulator. The expiratory gases can be expelled through a valve (notshown) in the mask, a further expiratory conduit (not shown), or anyother such method as is known in the art.

Mask Cushion

Referring now to FIGS. 3 and 4 in particular, the mask cushion 1104 isprovided around the periphery of the nasal mask 1102 to provide aneffective seal onto the face of the patient to prevent leakage. The maskcushion 1104 is shaped to approximately follow the contours of apatient's face. The mask cushion 1104 will deform when pressure isapplied by the headgear 2108 (see FIG. 7) to adapt to the individualcontours of any particular patient. In particular, there is an indentedsection 1150 intended to fit over the bridge of the patient's nose aswell as an indented section 1152 to seal around the section beneath thenose and above the upper lip.

In FIG. 4 we see that the mask cushion 1104 is composed of an innersealing member that is an inner cushion 1110 covered by an outer sealingsheath or member 1112. The inner cushion 1110 is constructed of aresilient material for example polyurethane foam, to distribute thepressure evenly along the seal around the patient's face. In other formsthe inner cushion 1110 may be formed of other appropriate material, suchas silicone or other composite materials. The inner cushion 1110 islocated around the outer periphery 1114 of the open face 1116 of thehollow body 1102. Similarly the outer sheath 1112 may be commonlyattached at its base 1113 to the periphery 1114 and loosely covers overthe top of the inner cushion 1110.

In the preferred embodiment of the present invention as shown in FIGS. 4to 6 the bottom of the inner cushion 1110 fits into a generallytriangular cavity 1154 in the hollow body 1102. The cavity 1154 isformed from a flange 1156 running mid-way around the interior of thehollow body.

The outer sheath 1112 fits in place over the cushion 1110, holding it inplace. The sheath 1112 is secured by a snap-fit to the periphery 1114 ofthe hollow body. In FIGS. 5 to 6 the periphery 1114 is shown includingan outer bead 1158. The sheath 1112 includes a matching bead 1159,whereby once stretched around the periphery; the two beads engage tohold the sheath in place.

A second preferred embodiment to the mask cushion is depicted in FIGS. 9and 10. In the second embodiment the inner cushion 2000 includes araised bridge 2002 in the nasal bridge region. The raised bridge 2002can also be described as a cut out section made in the cushion. Also,the notch in the contacting portion (between the inner cushion and outersheath) is less pronounced than proceeding embodiments. However, as theraised bridge 2002 is unsupported it is much more flexible and resultsin less pressure on the nasal bridge of the patient. The outer sheath2004 contacts the inner cushion 2000 throughout the raised bridge 2002.The peaks 2005, 2007, 2009, 2011 in the inner cushion 2000 between eachof the indented sections 2006, 2008 and the raised bridge 2002 contactthe outer sheath 2004 and when in use the sheath 2004 contacts thefacial contours of the patient in the regions of these peaks.

Referring particularly to FIG. 10 the inner cushion 2000 includes acheek contour 2006 to follow the cartilage extending from the middle ofthe nose, and a contoured lip sealing portion 2008 to seal between thebase of the nose and the upper lip.

Referring now to FIGS. 11 and 12 a third preferred embodiment of themask cushion is depicted, in this case, the inner cushion 2010 tapersdown 2012 towards the nasal bridge region 2014. For a short portioneither side of the nasal bridge region 2014 the inner cushion 2010 isabsent, forming a semi annular form in plan view as seen in FIG. 12.

Referring to FIG. 13, a fourth preferred embodiment of the mask cushionis depicted. The outer sheath 2020 is adapted to contact the innercushion 2022 completely about the inner cushion, including in the nasalbridge region 2024 and the check contour 2026. FIG. 18 shows the innercushion 2022 where the upper edge 2050 of the cushion does not have anycontours and thus will contact the outer sheath all around the edge ofthe inner cushion. FIG. 20 shows a sealing interface similar to that ofFIG. 13 where the inner cushion also follows and touches the outersheath all around its edge.

FIG. 14 illustrates a fifth preferred embodiment of the inner cushion2030. In the nasal bridge region 2032 the inner cushion includes a lowerbridge 2034 and upper bridge 2036. Due to the gap the upper bridge 2036is unsupported to reduce pressure on the patient's nasal bridge, but thelower rim 2034 of the inner cushion 2030 is continuous, which aidsinstallation.

In yet other forms of the sealing interface of the present invention theinner cushion may be provided with other contours on the front side ofthe inner cushion or cut outs on the back side of the inner cushion, sothat in the areas where there are regions cut out of the back side ofthe cushion the cushion is more flexible. In particular, cut outs in thenasal bridge, cheek and upper lip regions provide the patient with amask cushion that is more flexible and thus more comfortable. FIG. 15shows an embodiment of an inner cushion 2024 that has a curved cut outor dead space 2044 in the cheek region. FIGS. 16 and 17 show embodimentsof an inner cushion 2000 that has a cut out or dead space 2046 in thearea where the patient's upper lip rests in the foam.

A final form of a sealing interface is shown in FIG. 19, here the innerfoam member has an annular shape but has a thin bridge or membrane 2048that extends across and provides flexibility to the nasal bridge region.

Referring now to FIG. 21, to improve the comfort to the patient thenasal mask 200 includes a thin bridge section 203 in the nasal bridgeregion of the outer sealing member 201, that is, that part extendingover the bridge of a patient's nose.

Similar to described above the outer sealing member or outer sheath 201fits in place over the inner sealing member (inner cushion) 202, holdingit in place. The outer sheath 201 is secured by a snap-fit to theperiphery 205 of the mask hollow body 204. The periphery 205 is shownincluding an outer bead 206. The outer sheath 201 includes a matchingbead 207, whereby once stretched around the periphery 205; the two beadsengage to hold the outer sheath 201 in place.

The outer sealing member or sheath 201 is shown in more detail in FIGS.22 to 24. The outer sheath 201 has formed in it a region 203 that isthinner than the remainder of the cross-sectional thickness 210 of thesheath. In particular, the side walls 211, 212 (see FIG. 23) must bethicker than in the region 203 so as to provide structural support forthe sheath and ensure the sheath does not collapse in use, or when beingassembled with the mask body. As an example only, for a nasal mask, ifthe thin bridge region was 0.2 mm thick, the side walls may be 0.3 to0.6 mm thick. Therefore, the thin bridge region 203 is approximatelyhalf the thickness of the rest of the sheath 201 and so can provide asignificant effect, such that the pressure to the patient's nose in thenasal bridge region is reduced compared to when a sheath does not haveany reduced thickness section. Furthermore, a thin bridge region 203 inthe outer sheath 201 allows for different sized patient's to comfortablyuse the mask and outer sheath of the present invention.

In use, when a force is placed against the outer sheath 201 the thinbridge region 203 will collapse more than the rest of the outer sheath201. Therefore, this section 203 is more flexible and allows for addedpatient comfort.

Referring particularly to FIG. 22, the thin bridge region 203 on theouter sheath 201 preferably does not extend completely to the outer edge211 of the outer sheath 201, but grows thicker in thickness. This isbecause the outer edges of the outer sheath 201 when thicker are lessprone to tearing.

In particular, in FIG. 23, that outer sheath 201 is substantially heartshaped and the thin bridge region 203 is shown to extend more thanhalfway down the sides of the sheath from the apex 213. As shown in FIG.23, the thin bridge region 203 does not extend fully down the edges 211and 212 of the outer sheath 201. This is because support is required inthe edges of the sheath 201, to provide structural stability of thesheath.

In other forms of the nasal mask of the present invention, the thinbridge region may not extend as far as that shown in FIG. 23, but berestricted merely to the nasal bridge region (similar in manner to themask cushion shown in FIG. 30, in relation to a full face mask).

Full Face Mask

A further embodiment of the present invention is shown in FIGS. 25 to 31where the patient interface is a full face mask similar to thatdescribed in co-pending New Zealand patent application number 528029.The full face mask 300 includes a hollow body 302 and outer sealingmember or mask cushion 301. The cushion 301 is attached to the body 302in a similar manner as described with reference to the nasal mask, buthere no inner cushion is provided. Thus, the cushion 301 peripheryextends over a flange on the mask body.

The hollow body 302 has an integrally formed recess (not shown) in whichan insert 304 is fitted into. The recess and insert 304 each havecomplimentary circular apertures (generally indicated as 305) that forman inspiratory inlet when the insert 304 is placed in the recess. Theinlet 304 is capable of being connected to the tubing that forms theinspiratory conduit 3 (as shown on FIG. 1). Gases, supplied to theinspiratory conduit 3 from the CP AP device and humidifier, enter themask through the apertures 305 and the patient is able to breathe thesegases. The mask 300 is positioned around the nose and mouth of thepatient and headgear (not shown) may be secured around the back of thehead of the patient to assist in the maintaining of the mask on thepatient's face. The restraining force from the headgear on the hollowbody 302 ensures enough compressive force on the mask cushion 301 toprovide an effective seal against the patient's face.

The hollow body 302 and insert 304 are injection moulded in a relativelyinflexible material, for example, polycarbonate plastic. Such a materialwould provide the requisite rigidity for the mask as well as beingtransparent and a relatively good insulator. The mask cushion 301 ispreferably made of a soft plastics material, such as silicone, KRATON™or similar materials.

The cushion 301 of the mask 300 includes a thin bridge section 305 inthe nasal bridge region of the cushion 301, that is, that part extendingover the bridge of a patient's nose. As an example, in the region of thethin bridge section 305 the walls of the cushion may be 0.2 to 0.3 mmthick and the rest of the cushion may have a thickness of 1 mm. Inparticular, the side walls need to be thicker to provide support in thecushion, so that it does not collapse during use or assembly with themask body. In FIG. 29, this is particularly illustrated, as the section305 in the nasal bridge region is shown as being much thinner than therest of the cushion (in particular the bottom side wall region 306,which are much thicker in cross-section).

Note must be made that the inner flange 307 of the cushion 301 thatrests against the patient's face is also thinner in section than theside walls of the cushion 301 to provide flexibility to the cushion andthus comfort to the patient. In use, the inner flange 307 is the area ofthe cushion that seals against the patient's face and the side walls ofthe cushion provide stability to the cushion 301.

In use, when a force is placed against the cushion 301 the thin bridgesection 305 will collapse more than the rest of the cushion 301.Therefore, this section 305 is more flexible and allows for addedpatient comfort.

Other forms of the cushion that may be used with the full face mask ofthe present invention are shown in FIGS. 31 to 33 and each showalternative thin sections that may be provided for patient comfort, andto allow for fitting to different sized patients.

Referring first to FIG. 31, cushion 310 may have a thin bridge section311 that is narrower than that shown in FIG. 30.

In FIG. 32 the cushion 312 has a thin bridge section 313 only near theouter edge 317 of the cushion 312. This cushion 312 also had a thinsection 314 in the region of the cushion that would rest against thepatient's chin.

Finally, in FIG. 33, the thin section 316 of the cushion 315 may extenddown the sides 318, 319 of the cushion.

Forehead Rest

The nasal mask and/or full face mask of the present invention ispreferably provided with a fixed forehead rest (208, as shown inrelation to the nasal mask in FIGS. 21 and 23 or 303, as shown inrelation to the full face mask in FIG. 25). The forehead rest is notrequired to be adjustable as the cut out in the nasal bridge region ofthe inner foam (for the nasal mask) and the thin section in the outersheath (for both the nasal and full face masks) provides enoughflexibility of the mask cushion to provide fitting to a number ofdifferent patients.

What is claimed is:
 1. A breathing assistance apparatus comprising: amask body being hollow and having an opening, the opening configured toreceive a nose, or nose and mouth, of a patient, the hollow of the maskbody having a coupling portion that defines at least a portion of abreathing cavity, the mask body being formed of a relatively inflexiblematerial that provides rigidity for the mask; a sealing interfacearranged to surround the opening in the mask body and configured to bejoined to the coupling portion that defines at least a portion of thebreathing cavity, the sealing interface configured to be joined to thecoupling portion of the mask body in a sealing manner and the sealinginterface being configured to seal around the patient's facial contours,at least a portion of the sealing interface being formed of a relativelysofter plastics material when compared to the relatively inflexiblematerial of the mask body, the sealing interface comprising an outersealing member and an inner sealing member, the outer sealing memberhaving a thin region and a thick region, the thin region being locatedin a nasal bridge region configured to extend over and contact apatient's nasal bridge in use, the inner sealing member being absent inthe nasal bridge region; and a vent configured to allow expiratory gasesto be expelled and an elbow connector configured to connect between aconduit and the mask body.
 2. The breathing assistance apparatus ofclaim 1, wherein a first end of the elbow connector comprises anarrangement of slots configured to allow a portion of the elbow todeflect as the elbow is joined to the mask body.
 3. The breathingassistance apparatus of claim 1, wherein the thin region isapproximately half a thickness of the thick region.
 4. The breathingassistance apparatus of claim 1, wherein the sealing interface iscoupled to the mask body via a snap-fit.
 5. The breathing assistanceapparatus of claim 1, wherein a mounting portion of the sealinginterface is configured to join to the coupling portion of the maskbody, the mounting portion of the sealing interfacing comprising twowalls that define a channel.
 6. The breathing assistance apparatus ofclaim 5, wherein at least one of the two walls is received in a channeldefined in coupling portion of the mask body.
 7. The breathingassistance apparatus of claim 1, wherein the sealing interface is a fullface mask.
 8. The breathing assistance apparatus of claim 1, wherein theinner sealing member is made of silicone.
 9. The breathing assistanceapparatus of claim 1, wherein the mask body is made of polycarbonate.10. The breathing assistance apparatus of claim 1, wherein the outersealing member is made of silicone.
 11. The breathing assistanceapparatus of claim 1, wherein a side wall of the elbow comprises one ormore openings.
 12. The breathing assistance apparatus of claim 1 furthercomprising a forehead rest, wherein a rigid arm extends between andconnects the mask body and the forehead rest.
 13. The breathingassistance apparatus of claim 12 further comprising headgear configuredto apply a restraining force to the forehead rest to secure thebreathing assistance apparatus to the patient.
 14. The breathingassistance apparatus of claim 1, the outer sealing member comprising alip defining a patient-contacting surface that surrounds the opening,the opening having an uppermost extent, wherein a width of the thinregion tapers inward between an upper edge of the lip and the uppermostextent of the opening.
 15. The breathing assistance apparatus of claim14, wherein the thin region extends all the way to, and defines aportion of, a periphery of the opening.
 16. The breathing assistanceapparatus of claim 15, wherein each side of the thin region intersectsthe opening below the uppermost extent.
 17. A breathing assistanceapparatus comprising: a mask body being hollow and having an opening,the opening configured to receive a nose, or nose and mouth, of apatient; and a mask cushion configured to be joined to the mask body andarranged to surround the opening in the mask body, the mask cushionconfigured to seal around the patient's facial contours, the maskcushion having at least one indented section configured to accommodatethe patient's facial contours, and the mask cushion comprising: an outersealing sheath and an inner sealing member, the outer sealing sheathhaving a thin region located in a nasal bridge region and configured toextend over and contact a patient's nasal bridge in use, the thin regionhaving a reduced cross-sectional thickness compared to a remainder ofthe outer sealing sheath; the inner sealing member being absent in thenasal bridge region.
 18. The breathing assistance apparatus of claim 17,wherein the at least one indented section comprises a contoured regionalong a lower section of the mask cushion.
 19. The breathing assistanceapparatus of claim 18, wherein the contoured region is configured toseal around a section beneath the patient's nose and above the patient'supper lip.
 20. The breathing assistance apparatus of claim 17, furthercomprising a forehead rest.
 21. The breathing assistance apparatus ofclaim 17, further comprising headgear configured to be secured around aback of the patient's head.
 22. The breathing assistance apparatus ofclaim 17, wherein the inner sealing member is made of silicone.
 23. Thebreathing assistance apparatus of claim 17, wherein the outer sealingmember is made of silicone.